Solid Organ Transplantation in Korea: 1997

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Abstract

During the year of 1997, total 1,061 solid organ transplantations were performed at 40 centers in Korea: 962 kidney transplantations at 40 centers, 64 liver transplantations at 7 centers, 29 heart transplantations at 5 centers, 3 pancreas transplantations at 1 center, and 3 heart-lung transplantations at 2 centers. (Kidney) There were 962 kidney transplantations including 56 retransplantations (5.8%). Living related donors were 459 (47.7%), living unrelated donors were 327 (34.0%), and cadaveric donors were 176 (18.3%). Nineteen centers of 40 performed kidney transplantation less than 10 cases. Donors and recipients were largest at 3rd and 4th decades. Cadaveric donor kidneys were procured at the same transplant center in 158 (89.8%). Multiorgan procurement technique was used in 81 cases (46.0%). The most common cause of donor death was traffic accident (56.8%). Chronic GN was the most frequent disease for ESRD (33.2%). Three or less HLA antigen mismatch was more than half the cases (57.2%). Cadaveric donor transplantation was performed within 12 hours of cold ischemia time in 93.8%. Triple regimen immunosuppression (AZA+CSA+ PDS) was used in 54.0%. Acute rejection occurred in 252 patients (26.2%). Overall response rate with antirejection therapies was 75.7%. Among 962 patients, 19 patients was dead with 6 (0.6%) operative mortality. Graft losses were 39 (4.1%.). (Liver) There were 64 liver transplantations. Living related partial liver transplantation was performed in 33 (51.6%). Donors were most frequent in the third and fourth decade groups. Recipients were most frequent in the first decade group. Cadaveric donor liver was obtained from the same transplant center in 24 (77.40%). The most frequent cause of hepatic failure was chronic viral hepatitis (25) in adults and biliary atresia (13) in children. Status 3 was the most common medical status of recipients (62.5%). Cadaver donor liver transplantation was performed within 12 hours of cold ischemia time in 96.8%. Triple regimen immunosuppression was used in 31.3% and FK506 based regimen in 37.5%. Acute rejection occurred in 17 patients (26.6%). Overall response rate with antirejection therapies were 78.3%. Among 64 patients, 20 were dead with 13 (20.3%) operative mortality. (Heart) There were 29 heart transplantations. Donors were most frequent in the third decade group. Recipients were most frequent in the fourth decade group. Heart was obtained from the same transplant center in 21 (72.4%). The most frequent cause of heart failure was idiopathic cardiomyopathy (23). All heart transplantations were performed within 4 hours of cold ischemia time. Triple regimen immunosuppression was used in 75.9%. Acute rejection occurred in 10 patients with 100% response rate. Among 29 patients, 2 were dead without operative mortality. (Pancreas) There were 3 pancreas transplantations. All were juvenile diabetes patients. All three were harvested by multiorgan procurement technique, two at the same transplant center. Cold ischemia time was less than 12 hours and quadruple immunosuppression was performed in all. All were surviving and only one patient needs insulin treatment with reduced dose. (Heart-Lung) First heart-lung transplantations was performed in 1997 and three transplantations were performed. All were double lung transplantations. Causes of lung disease were idiopathic pulmonary fibrosis and of heart diseases were Eisenmenger's diseases. Two of three heart-lungs were procured at the other transplant center with multiorgan harvest technique. Cold ischemia time was less than 8 hours and all were alive. (1-year follow up results of transplantations in 1996) In 941 kidney transplantations, there were 48 (5.1%) graft losses including 21 dead patients. 1-yr actual graft and patient survival rates were 94.9%, 97.8%, respectively. Cadaveric donor transplantations showed comparable results to those of living donor. Living unrelated donors had tendency to be lower graft survival rate than other donor sources. In 48 liver transplantations, 18 patients (37.5%) were dead with 15 (31.3%) operative mortality. 1-yr actual graft (patient) survival rate was 62.5%. In 20 heart transplantations, 5 patients (25.0%) were dead with 3 (15.0%) operative mortality. 1-yr actual graft (patient) survival rate was 75.0%. In 2 pancreas transplantations, one patient died of fungal infection. In 2 lung transplantations, all were dead within one year. Kidney transplantations showed comparable survival rates to those of western countries, however, other organ transplantations seem to need more time periods and efforts for the good outcomes.